title: Clinical and immunological aspects of post-kala-azar dermal leishmaniasis in Bangladesh.
abstract: We conducted active surveillance for kala-azar and post-kala-azar dermal leishmaniasis (PKDL) in a population of 24,814 individuals. Between 2002 and 2010, 1,002 kala-azar and 185 PKDL cases occurred. Median PKDL patient age was 12 years; 9% had no antecedent kala-azar. Cases per 10,000 person-years peaked at 90 for kala-azar (2005) and 28 for PKDL (2007). Cumulative PKDL incidence among kala-azar patients was 17% by 5 years. Kala-azar patients younger than 15 years were more likely than older patients to develop PKDL; no other risk factors were identified. The most common lesions were hypopigmented macules. Of 98 untreated PKDL patients, 48 (49%) patients had resolution, with median time of 19 months. Kala-azar patients showed elevated interferon-γ (IFNγ), tumor necrosis factor-α (TNFα), and interleukin 10 (IL-10). Matrix metalloproteinase 9 (MMP9) and MMP9/tissue inhibitor of matrix metalloproteinase-1 (TIMP1) ratio were significantly higher in PKDL patients than in other groups. PKDL is frequent in Bangladesh and poses a challenge to the current visceral leishmaniasis elimination initiative in the Indian subcontinent.
authors.affiliation: Children's Hospital and Research Center, Oakland, California, USA. sizuba@yahoo.com
authors.forename: Shamim
authors.initials: S
authors.lastname: Islam
authors.forename: Eben
authors.initials: E
authors.lastname: Kenah
authors.forename: Mohammed Ashraful Alam
authors.initials: MA
authors.lastname: Bhuiyan
authors.forename: Kazi Mizanur
authors.initials: KM
authors.lastname: Rahman
authors.forename: Brook
authors.initials: B
authors.lastname: Goodhew
authors.forename: Chowdhury Mohammad
authors.initials: CM
authors.lastname: Ghalib
authors.forename: M M
authors.initials: MM
authors.lastname: Zahid
authors.forename: Masayo
authors.initials: M
authors.lastname: Ozaki
authors.forename: M W
authors.initials: MW
authors.lastname: Rahman
authors.forename: Rashidul
authors.initials: R
authors.lastname: Haque
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: James H
authors.initials: JH
authors.lastname: Maguire
authors.forename: Diana
authors.initials: D
authors.lastname: Martin
authors.forename: Caryn
authors.initials: C
authors.lastname: Bern
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001459:Bangladesh / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D017364:Collagenases / Q000097:blood; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D015994:Incidence; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology* / Q000473:pathology*; D007898:Leishmaniasis, Visceral / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D061965:Matrix Metalloproteinase Inhibitors / Q000097:blood; D008875:Middle Aged; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; D016207:Cytokines; D061965:Matrix Metalloproteinase Inhibitors; D017364:Collagenases